| |
1280a Main St Altavista VA 24517-1465 | |
(434) 309-1165 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 1280a Main St, Altavista, Virginia |
Authorized Official Name and Position | Lewis Addison (SR VP, CFO) |
Authorized Official Contact | 4342003656 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1204 Fenwick Dr Lynchburg VA 24502-2112 Ph: () - | 1280a Main St Altavista VA 24517-1465 Ph: (434) 309-1165 |
NPI Number | 1164720058 |
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Provider Enumeration Date | 03/02/2011 |
Last Update Date | 11/14/2012 |
Identifier | Type | State | Issuer |
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1164720058 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |